The depletion of groundwater resources in arid regions has made the reassessment of the qanat’s role in both structural and socio-cultural sustainability increasingly necessary. This study employs field surveys and statistical analysis of data collected through 39 questionnaires using SPSS and Python to examine the relationships among the architectural typologies of the qanat’s outlet, the quality of building materials, and the management conditions of 10 selected qanats in South Khorasan Province. The study population comprised two main groups—technical experts (including architects and heritage conservators) and farmers/landowners. A multivariate analysis between architectural form and perceived safety indicates that covered and chambered typologies significantly enhance safety perception, while they reduce the dispersion of respondents’ views compared with exposed structures. A comparative evaluation of the hydro material sustainability index based on materials demonstrates the statistically higher performance of traditional materials (stone and sarooj) over modern ones (concrete and cement) in terms of technical and climatic sustainability, whereas modern materials produce a notable decline in the index of architectural authenticity (heritage value). Furthermore, multivariate analysis reveals a tension between functional priorities and value-based criteria: modern materials exhibit higher durability but a substantial loss in architectural authenticity, whereas traditional materials better preserve this balance. The management-oriented diagnostic assessment shows that functional neglect, the absence of preventive maintenance, and incompatible restoration practices are the primary drivers of the transition of qanats into a semi-active and fragile condition. The qualitative findings also emphasize that improving qanat sustainability requires the simultaneous integration of technical, environmental/climatic, and social dimensions,